"Nationwide Healthcare Lawyers"
(April 10, 2018): On April 2, the Centers for Medicare and Medicaid Services (CMS) announced an expansion of the benefits that private health plans may offer Medicare beneficiaries under the Medicare Advantage (MA) program in 2019. In its Final Call Letter for bids from plans that participate in the MA program (“MA plans”) for 2019, […]
Medicare Advantage Plans May Soon Offer Personal Care Services Read More »
(April 2, 2018): Our nation’s demographics are changing. In less than 20 years, it is estimated that for the first time in country’s history, the number of individuals over the age of 65 will exceed the number of children.[1] These increases are already being seen in our rapidly expanding Medicare healthcare benefit program. At last
The PSAVE Pilot Program: Should You Self-Audit Your Medicare Claims? Read More »
(January 25, 2018): On January 23rd, the Veteran Administration (VA) and the Centers for Medicare and Medicaid Services (CMS) announced a “partnership to strengthen prevention of fraud, waste and abuse.” According to the press release, under this partnership: “VA plans to capitalize on the advancement in analytics CMS has made by concentrating on its use
Veterans Administration and CMS Announce Partnership to Address Fraud Prevention Read More »
(December 14, 2017): The Centers for Medicare and Medicaid Services (CMS) has engaged various types of outside contracting entities to perform program integrity functions on behalf of the Medicare program. At the present time, Uniform Program Integrity Contractors (UPICs) and Zone Program Integrity Contractors (ZPICs) are very aggressive when it comes to referring evidence of
Revocation of Your Medicare Billing Privileges Read More »
(November 29, 2017): The Medicare and Medicaid programs are managed by the Centers for Medicare and Medicaid Services (CMS). CMS has engaged Unified Program Integrity Contractors (UPICs) and Zone Program Integrity Contractors (ZPICs), among others, to provide program integrity support. In the course of their duties, UPICs and ZPICs may initiate a prepayment review, postpayment
UPIC / ZPIC Referrals to State Boards, Societies, Surveyors and QIOs Read More »
(August 16, 2017): Earlier this summer, the U.S. Department of Justice (DOJ) executed its most extensive “health care fraud takedown” to date, initially arresting 412 licensed healthcare providers, doctors, and nurses alleged to have engaged in fraudulent conduct (additional arrests were made in the days following the takedown). As Attorney General Jeff Sessions stated at
Pain Management Prescribing Practices and Audits. Read More »
(June 30, 2017): In March 2016, the Centers for Disease Control and Prevention (CDC) published “CDC Guideline for Prescribing Opioids for Chronic Pain – United States, 2016” [1] in an effort to address the seemingly ever-increasing deaths that have been attributed to opioid-related overdose. A number of states have passed legislation or enacted regulatory provisions
Maryland Limits on Opioid Prescriptions Read More »
(June 29, 2017): Deaths resulting from a drug overdose have grown considerably in recent years. The results of a study published in “Morbidity and Mortality Weekly Report” by the Centers for Disease Control and Prevention (CDC) found that 63.1% of the overdose-related deaths in 2015 involved opioids. Notably, this was a significant increase from the
Indiana Opioid Prescribing Guidelines–Eff. July 1, 2017. Read More »
(June 29, 2017): It has been estimated that from 1999 to 2014, more than 165,000 persons died from an overdose of opioid medications in the United States. Researchers also noted that during this same time period, sales of opioids increased in proportion to the rise in deaths resulting from an opioid-related overdose. In an effort
Opioid Prescribing Practices & NBI MEDIC / UPIC / ZPIC and Board Actions Read More »
(June 28, 2017): The Medicare program is enormous. As of 2016, more than 56 million individuals participated in the program, with more than 10,000 additional individuals enrolling in the program each day. The Centers for Medicare and Medicaid Services (CMS) is the agency responsible for managing this costly program. To direct this $640 billion program,
NBI MEDIC Referrals to Boards, OIG and DOJ are Here! Read More »